Prior Authorization Information

Prior authorization is a process used by many insurance copanies to determine if a procedure, service, or medication will be covered.  Most insurance companies are now requiring prior authorization for certain genetic and molecular laboratory testing.  

Prior Authorization Process

  1. Complete the following form:  Prior Authorization Request Form
  2. Include a legible copy of the front and back of the patient’s insurance card
  3. Send relevant clinic notes (i.e. ultrasound report, pathology reports, office visits, genetic counseling notes, previous testing, etc.)
  4. Send above information to our Billing Support team by:
    • rpsbillingsupport@unmc.edu  |  fax (402-559-8359)

What to expect after submitting a request?

  • An 'Insruance Authorization Update' will be sent in nealry all cases to the ordering provider (by the method designated in section D of the prior auth form).
    • Testing automatically proceeds if the out of pocket setimate is $100 or less and the specimen has been received by the laboratory.
  • The provider/ordering facility is responsible for coordinating specimen collection and shipment to our laboratory after authorization update has been communicated.

What to do if prior authorization is denied or testing is not a covered benefit?

Even if prior authorization is denied or an insurance policy excludes the service for your patient, the patient may still seek testing but will be responsible for the cost of testing.  Please also submit the Patient Consent for Non-Covered Lab Services Form. RPS offers financial assistance for patients who meet criteria and you can reach out to our billing team to review payment options.


Common Testing Requiring Prior Authorization:

Please note this is not an all-inclusive list of tests that require prior authorization or have limited coverge.  The patient's insurance company should be contacted for plan specific details.

Test Code

Test Name

CPT Code(s)

UHC Molecular Test Code

AATM

Alpha Antitrypsin Pyrosequencing

81332

56281332

BCRRT

BCR ABL Qualitative

81207   

56281207

BCRQNT

BCR ABL Quantitative p210

81206

56281206

BRAF

BRAF Mutation Detection

81210

56281210

CALRM

Calrecticulin Exon 9 Mutations

81219

56281219_CALRM

CEBPA

CEBPA Gene Analysis

81218

CEBPA82

VARIES CODES

Chromosome analysis

*see our website for other sample types and their codes

88230,88262, 88262, 88280, 88285 and 88289  

n/a

EWNGS

Ewings by RT-PCR

81401

56281401

PROTH

Prothrombin Factor II

81240

56200038A

VARIES CODES

FISH Analysis

88271, 88275

N/A

FLT3

FLT3 ITD Mutation Detection

81245

56281255

FLTTKD

FLT3 TKD Mutation

81479

56200050

FRGX

Fragile X Mutation Analysis, Modified by CE

81243

56281243

GIP

Gastrointestinal Pathogen Panel

87507

GIP

PCRIG

IgH Gene Rearrangement by DNA

81261

56281261

JK2E12

JAK 2 Exon 12 Seq Detection by NGS

81479

56200032_JK2E12

JAK2

JAK2 Mutation Detection by NGS, Qualitative

81479

56281271_JAK2

LEYDN

Leiden Factor V

81241

56200038B

MSI

Micro Satellite Instability

81301

n/a

VARIES CODES

Microarray Analysis

81229

* Molecular testing code differs depending on testing reason/sample type. See our website for specifics

MLH1

MLH1 by PCR       

81288

MLH1M87

MPLM

MPL by NGS Mutation Detection

81479

56281339

MYD88/MYDBM

MYD88 Gene Analysis

81305

56200041

MYMPO/MYMPB

Myeloid Mutation Panel

81450

56200036

MPNBM/MPNPB

Myeloproliferative Neoplasm by NGS

81450

56200023

NPM1

NPM1 Mutation

81310

56281310

RESPP

Respiratory Pathogen Panel

0202U

n/a

0020

Rhabdomyosarcoma by RT-PCR

81401

56281407

RHD

RHD Genotype

81403

n/a

STPP

Solid Tumor Precision Panel

81445

56200048

0030

Synovial Sarcoma by RT-PCR            

81401

56281408

TGAMA

T Gamma Gene Rearrangement by DNA

81342

56281342

TP53

TP53 Mutation Detection by NGS*

81352

56281352

TMB

Tumor Mutation Burden Assay

81479

56200049

YCMD

Y-Chromosome  Micro-Deletion

81403

55801005

* For your patients with commercial United Healthcare insurance plans, we have updated this information on the UHC Test Directory. Please make sure you utilize the updated test codes listed below when requesting prior authorization online.

If you have any questions or need assistance with prior authorizations please contact our billing department at 402-559-9480